Eczema (Skin Condition) Flashcards
Background
Eczema and dermatitis are exchangeable terms for the same condition but dermatitis more used for contact indicated conditions.
Eczema is inflammatory skin disorder. Classed as:
- Endogenous = due to individual susceptibility
- Exogenous = due to external factors
Can also be classed as Acute or chronic.
Acute - swollen itchy skin due to the escape of fluid from dilated dermal blood vessels into epidermis causing oedema and swelling. May lead to the formation of blisters or vesicles, which may rupture on thinner areas of the skin and cause exudation (escape of liquids) and crusting.
Chronic - Presents with less oedema and vesicles, more thickening of the skin, becoming increasingly dry and scaly, with painful fissures and lichenification (thickened, hardened area of skin) of the skin due to rubbing and scratching.
Triggers
dry and hot environments, irritants such as soap and water, stress or infections (staphylococcus or herpes)
common allergens such as pollens and dust mites
Signs and symptoms
Chronic will tend to be lichenfied from the rubbing and scratching.
With age eczema pattern will change.
ATOPIC
itchy, red, dry skin which can become infected and lichenfied.
Vary by age:
Infant - dry, scaly and red. Cheeks and Napkin area affected.
Toddlers - more localised and thickened. Effects outer joints (wrists, elbows, ankles, knees).
School age - elbows and knees, eyelids, earlobes, neck and scalp. Recurrent, acute, itchy blisters on the palm, fingers, or feet (vesicular hand/foot dermatitis). Can get small coin-like areas of eczema scattered over the body (nummular dermatitis)= dry, red, and itchy and mistaken for ringworm. By teens eczema can clear
Adults - hands, eyelids, flexures, nipples. Dry and lichenfied.
CONTACT
Allergic: itchy skin goes after a few hours of contact with allergen. Settles after a few days if allergen is gone.
Irritant: Chemicals or physical agents damage the surface of the skin faster than the skin can repair the damage.
Often localised. Glazed surface look. Redness, itching, swelling, blistering and scaling of damaged area.
The severity is highly variable and depends on many factors:
- Amount and strength of the irritant.
- Length and frequency of exposure.
- Skin susceptibility (thick, thin, oily or dry skin).
- Environmental factors (high/low temperature or humidity).
Other
Seborrhoeic Dermatitis: Post puberty, affects areas with large amounts of sebaceous glands like face and scalp.
Skin becomes red, with greasy yellow scales or dandruff on the scalp.
Discoid dermatitis: common on forearms and lower legs. Itchy, circular patches. 2ndry infection can occur.
Varicose or Stasis Dermatitis: Main causes = varicose veins, oedema of. lower legs, varicose ulceration.
Asteatotic Dermatitis: Common in elderly, due to dryness of the skin and worse with soap use
Diagnosis
Take history, examine rash (look at signs and symptoms to asses type of eczema)
Patch test can help find allergen for allergic dermatitis.
Treatment (general)
Goals:
Decrease skin inflammation, eliminate exacerbating factors, and separate each topical product use by 30 min.
Cream for weeping dermatitis
Ointments for dry dermatitis
Lotion for hairy areas
BNF/CKS:
Firstly, remove triggers.
Emollient for dry skin and itching. Can also get bath/shower emollients.
Emollients should be used when PRN or maintenance even when eczema is settled. (E45, diprobase =thin) (Thick = Ointments diprbase, cetraben)
Topical Corticosteroid - potency dependent
MILD - Eczema on the face, genitals, or arm pit. (Hydrocortisone). Increase to moderate if needed.
MODERATE - POTENT - Adults with moderate or severe eczema on the scalp, limbs, and trunk. (Clobetasone [moderate] betamethasone [potent]) Review frequently.
If they have FREQUENT FLARES can use topical Corticosteroid to prevent.
Specialist may use ichthammol with zinc oxide bandage over topical steroid or emollient.
Mild - moderate atopic eczema 2nd line topical pimecrolimus.
Moderate - Severe atopic eczema 2nd line topical Tacrolimus. Initiated by specialist only.
Non sedating Antihistamines can be given for severe itching or urticaria.
Infection
Depends on patients preference and if infection is local.
Topical 1st line fusidic acid (LOCAL)
Oral 1st line flucoxacillin
ALT Clarithromycin or Erythromycin (pregnancy).
Severe refractory eczema
Systemic drugs acting on the immune system (eg ciclosporin, azathioprine [unlicensed], mycophenolate mofetil [unlicensed]) or phototherapy can be used for severe form; under specialist supervision.
Dupilumab and baricitinib options for moderate - severe atopic eczema.
Alitretinoin - severe chronic hand eczema refractory to potent topical corticosteroids; patients with hyperkeratotic features
Seborrhoeic dermatitis
Shampoos active against the yeast (inc. ketoconazole or coal tar 1s) and COMBO of mild topical corticosteroids with suitable antimicrobials are used.
Treatment atopic eczema CKS
Mild:
Emollient
Topical corticosteroid untill 48 hrs after symptoms gone (applies to all steroid use in eczema unless maintenance)
Moderate:
Inflamed skin - betamethasone. Delicate areas Hydrocortisone increase dose if needed.
Bandages can be used (special 1s)
Severe itch or urticaria 1 month trial non sedating Antihistamines
PREVENTION treatment - topical steroid control flares. 2nd line topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Severe:
Skin inflammed same as moderate but for delicate areas use betamethasone or clobetasol instead.
(NO potent steroid for <1 yr old)
Bandages
Severe itching or urticaria - as above
- If itching affects sleep use sedating Antihistamines MAX 2 weeks.
Severe, extensive eczema causing psychological - oral steroid 30mg prednisolone 1 week.
Prevention - SAME AS moderate
No response after 1 week REFER urgently. Do routine checks at dermatologist
INFECTED:
Same as other section.
Types of Eczema
irritant contact, allergic contact, atopic, venous, and discoid.
Atopic most common
